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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530032
Report Date: 05/04/2023
Date Signed: 05/04/2023 03:31:27 PM


Document Has Been Signed on 05/04/2023 03:31 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:VILLA DE ANZAFACILITY NUMBER:
335530032
ADMINISTRATOR:KATHERINE A. TREVINOFACILITY TYPE:
740
ADDRESS:5881 EL PALOMINO DRIVETELEPHONE:
(951) 683-3333
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:197CENSUS: 104DATE:
05/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH: Executive Director Partrick Lee McAdoo-MortonTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Javier Prieto conducted an unannounced case management visit. The purpose of today’s visit was to assure staff Victoria Renee Mainor is no longer working at the facility. LPA met with The exclusion of Mainor is based on a Decision and Order to exclusion.

LPA Prieto explained that to Executive Director Partrick Lee McAdoo-Morton. Mainor is not allowed to be present in the facility. Executive Director understands this Immediate Exclusion and has agreed Manior cannot be allowed to work and/or live in a CCL Licensed facility and have contact with residents in any child day care or residential facility licensed by the California Department of Social Services. Director produced records stating Mainor was last present and employed at the facility on 04/14/2023

An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier PrietoTELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:
DATE: 05/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/04/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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